The study objective is to advance the utility of the electronic health record (EHR) for patients and clinicians by optimizing the design of the EHR-generated clinical after-visit summary (AVS). This will be achieved through key stakeholder input, a streamlined process for populating the AVS to increase clinician efficiency, and use of evidence-based communication strategies for print materials to improve patients' comprehension, retention, and use of the information. The AVS is given to patients after a clinical encounter to inform them of key clinical, illness self-management, and follow-up and referral information. New regulations and incentives, including Meaningful Use and patient- centered medical home initiatives are leading to greatly expanded use of the AVS. While the goal of promoting the AVS is to achieve greater patient-centeredness, we have found that AVS in many clinical practices have high reading grade levels, great variation in content and order of content, and variable understandability and usability as assessed with validated instruments. The Institute of Medicine recently reported that research is needed to improve the design of the AVS to achieve its potential as a patient information and educational tool. We propose an EHR-integrated enhanced AVS (eAVS) whose design is driven by key stakeholders (clinicians, clinical staff, patients and caregivers) and which incorporates evidence-based strategies for communicating printed health information to maximize comprehension and usability of the document. The Specific Aims of this study are to: (1) Develop and refine a patient-centered eAVS that is easy for clinicians to use and contains patient-centered information that is understandable and actionable by patients and caregivers, including those with low health literacy; (2) Pilot test the eAVS to assess the experience of patients and providers, process, and impact on patients' understanding of their medication regimens, medication adherence, and appointment keeping. In Phase I, we will conduct qualitative interviews with medical directors from advanced primary care practices throughout the US to learn about the features of their AVS and the features that work well and those that don't. We will also conduct focus groups with patients, clinicians and clinical staff. We will use this qualitative data to design the eAVS and work with EHR programmers to optimize its integration in the Epic EHR. In Phase II, we will conduct a cluster randomized controlled trial in 4 primary care practices (n=300 patients) to compare outcomes using the eAVS and the standard AVS currently in use. Researchers from Mount Sinai Hospital and Northwestern University will collaborate on eAVS development. The multi-disciplinary team is comprised of experts in health services research, medical informatics, qualitative methods, health literacy and healthcare communication, and clinicians. This project represents a rigorous and comprehensive effort to advance the utility of the EHR and its alignment with the national effort to advance patient-centered care.